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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204374
Report Date: 12/08/2025
Date Signed: 12/08/2025 02:10:18 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/04/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251204140218
FACILITY NAME:SIMLA VILLAS INC.FACILITY NUMBER:
198204374
ADMINISTRATOR:SIMLA MEHTAFACILITY TYPE:
740
ADDRESS:16623 ARDMORE AVENUETELEPHONE:
(562) 804-3603
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:15CENSUS: 13DATE:
12/08/2025
UNANNOUNCEDTIME BEGAN:
11:29 AM
MET WITH:Jennifer Bobodilla, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff left resident soiled overnight.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Tena Herrera and Gabriela Castro conducted an unannounced complaint visit to investigate the above allegation. LPAs met with Jennifer Bobodilla and explained the purpose for todays visit.

The investigation consisted of the following:

LPAs obtained copies of staff and client rosters, documents within Resident #1's (R1) file that include: Physician Report and Home Heath Plan. LPAs interviewed 3 Staff (S1-S3) and 6 Residents (R1-R6).

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 28-AS-20251204140218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SIMLA VILLAS INC.
FACILITY NUMBER: 198204374
VISIT DATE: 12/08/2025
NARRATIVE
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The investigation revealed the following:

Allegation: Staff left resident soiled overnight.
It is alleged that R1 was left soiled and dirty by facility night staff. LPAs checked supplies for incontinence care and observed a sufficient supply within the facility and extra supplies in the detached garage. LPAs reviewed R1’s physician report and Home Health Care Plan, and it was noted that R1 uses a condom catheter that they are able to drain themselves. LPAs interviewed 3 staff and each denied the allegation and stated that R1 does not use diapers or require caregivers to provide incontinence care as R1 uses a condom catheter that they are able to drain themselves. LPAs interviewed a total of 6 residents and 5 out of 6 residents denied the above allegation and stated that they do need the use of incontinence care and staff provides the required care for them, last rounds are done around 9pm and they are provided with an overnight, extra absorbent diaper and a bed pad, and the first round the next morning by 7am. 5 out of 6 residents stated they had not issues or concerns when in regards to their incontinence care needs.

Based on statements and interviews conducted with staff/residents, and review of R1's file, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2025
LIC9099 (FAS) - (06/04)
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